Anxiety, sleep quality and dementia caregiving: An underexplored combination

By Elien Van Hout

There is considerable evidence supporting that caring for a person with dementia has an impact on the wellbeing of family carers. So, it is not surprising that anxiety symptoms among those carers are reported to be higher than the general population, with 32 % of family carers of people with dementia reporting increased levels of anxiety symptoms. Despite this, anxiety is underexplored in the research to date. When looking at existing interventions, we see a similar pattern where most carer interventions are not as effective for anxiety as they are for depression and burden. Understanding factors affecting anxiety symptoms can help to refine existing carer interventions, and consequently, further improve the well-being of family carers of people with dementia. This was the key aim of our recently published study. We particularly looked into how the different aspects of sleep quality may impact anxiety symptoms among family carers of people with dementia.

Various aspects of the quality and patterns of sleep such as sleep latency (i.e., how long it takes to fall asleep), sleep duration, habitual sleep efficiency (i.e., the percentage of time in bed that one is asleep), sleep disturbances, use of sleep medication, daytime dysfunction and the individual’s perception of sleep quality are considered to contribute to overall sleep quality, the measurement of how well people are sleeping. Furthermore, such different aspects of sleep quality are known to have a distinctive impact on the mental health of individuals. Although previous literature reports that more than half of family carers have poor overall sleep quality due to their caregiving role, the distinctive impacts of different aspects of sleep quality in family carers of people with dementia had yet to be studied.

Our recent study found that worse sleep quality predicts higher levels of anxiety symptoms in family carers of people with dementia. When looking at the different aspects of sleep quality, we found that the individual’s feelings on sleep quality (i.e. perceptions of sleep quality and sleep disturbances) seem to predict anxiety symptoms more strongly than sleep parameters (e.g. sleep latency and sleep duration), which are more objective indices. This means that carers who feel that their sleep quality is poor and their sleep is often disturbed during the night are more likely to report higher levels of anxiety symptoms regardless of how many hours of sleep they typically get.

Carers’ quality of sleep is known to diminish as dementia progresses due to the increased care challenges (e.g. the care recipient’s frequent awakenings during the night). Following the finding of our study, we recommend providing treatment that can directly target perceptions of sleep quality (subjective sleep quality) and sleep disturbances in order to prevent exacerbation of anxiety symptoms among family carers of people with dementia.

Existing interventions such as Cognitive Behavioural Therapy for Insomnia (CBT-I) are shown to be effective in managing sleep disturbances across multiple populations. Moreover, CBT-I is also considered to be effective in improving sleep quality in people with dementia. Given its effectiveness on both the person with dementia and the general population, a dyadic (both for the carer and the person with dementia) CBT-I intervention may be particularly beneficial in this population. In addition, recent literature shows mindfulness-based interventions may have the potential to improve perceptions of sleep quality (subjective sleep quality) among family carers. Therefore, it is recommended that future research investigates the impact of tailored interventions for managing anxiety symptoms among carers, such as exploring whether those evidence-based sleep interventions (i.e. mindfulness-based interventions and dyadic CBT-I) improve anxiety symptoms in family carers of people with dementia.

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Article Details
Examining the Impact of Different Components of Sleep Quality on Anxiety Among Family Carers of People with Dementia
Elien Van Hout, Milena Contreras, Eneida Mioshi, and Naoko Kishita
First Published Online April 18, 2022
DOI: 10.1177/08919887221093359
Journal of Geriatric Psychiatry and Neurology

About the Author

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Elien Van Hout, MSc, is a Postgraduate Researcher in Health Sciences at the University of East Anglia in Norwich, United Kingdom. Her research explores mental health, relationship dynamics, caregiving stressors, and underlying psychological processes among family carers of people with dementia. She is specifically interested in which of those factors affect anxiety symptoms among those carers and how we can tailor interventions to target these factors.